Hi,
I just came across this forum as i was doing alot of internet browsing to find more information on food challenges, lab values etc..
My son is 10yrs old and we discovered he had nut allergies when he was around 2yrs. I gave him some peanut butter on bread and within minutes he developed hives wherever the PB touched and his eye swelled shut. After testing it was found that he also tested positive on his skin tests to just about every tree nut there is, although he has never injested them to date. Recently we visiited a new allergist who felt that my son was a good candidate for a food challenge on all his nut allergies. His skin test for peanut was neg. and RAST showed .36, so the doc felt he would likely pass the challenge, we did it on Tues. and i'm thrilled to say he pased!!!! Now he has to eat it weekly for a month and after that at least a few times a month. We have the tree nut challenges booked for april-aug as the doc only does them once a month. So here i am soooo thrilled that the peanut is one less thing we have to worry about.
So my questions regaurding the food challenges is I suppose more about lab values than anything else. On most of his tree nuts his RAST levels were anywhere from. .40-.90...doc said this is very low and those levels may just be reflecting the fact that he has never eaten the tree nuts before. His skin tests do show positive for most of the tree nuts still. I should have asked the doc these questions but you know how rushed some visits can be. Do you think he would have sucessful food challenges?

What are the odds that he could have outgrown these too? I think i read something like 10%.

Anyone had similar experence?

If a 'normal' person who has no allergy to nuts had a RAST what would there levels be in comparison to an allergic child?

My son has always had very sensitve skin, you just touch him and he gets a red mark. Could it be the skin test is reflecting that and not a true allergy?

Do you think that now that my son is eating peanuts it could affect the tree nut allergies in a positive way..make him less allergic?

As you see we still have many questions. Unfortunately our next visit isn't until March when the doc will redo his skin test and see if things have changed,.I guess these questions aren't urgent, just curious. We do trust this new allergist and figure he must know what he is doing. He said since my son has never ingested a tree nut he would challenge a child with values as high as 5. The kids who have eaten the nut in their lifetime he challenges up to a 2 value. He figures my son is probably as low as he will go with his values since he is avoiding them. He also feels that if we wait and don't challenge him we may indeed be avoiding something he doesn't have to, thus potentially creating a worse or new allergy.

Where does your allergist practise? It is interesting to hear the level at which he will test. Our daughter has had test results which are somewhat contradictory but we have been advised to wait until she was older to challenge her. Her egg RAST is at 1.09 but her skin test to it is always quite large. This spring we are going to test her again for this. Her peanut skin test is always very mildly positive but her RAST is high for it (16 I think it was last time).

Anyways I wondered about over reactive skin on skin tests also but the allergists are supposed to do a positive and negative control test on the skin. If the negative control test comes up positive then it would be a sign that the skin is reacting to everything.

I don't know if RASt results of non-allergic people have been studied. I have wondered the same thing.

Congratulations on the peanut challenge. How many RAST tests has your son had for peanut? Did they gradually go down over time?
Kate

_________________13 year old daughter -- lives with life-threatening allergies to milk, tree nuts and peanuts; seasonal allergies (birch, maple, ragweed); pet allergies; asthma; and eczema10 year old son - no allergies

[quote="katec"]Where does your allergist practise? It is interesting to hear the level at which he will test. Our daughter has had test results which are somewhat contradictory but we have been advised to wait until she was older to challenge her. Her egg RAST is at 1.09 but her skin test to it is always quite large. This spring we are going to test her again for this. Her peanut skin test is always very mildly positive but her RAST is high for it (16 I think it was last time).

Anyways I wondered about over reactive skin on skin tests also but the allergists are supposed to do a positive and negative control test on the skin. If the negative control test comes up positive then it would be a sign that the skin is reacting to everything.

I don't know if RASt results of non-allergic people have been studied. I have wondered the same thing.

Congratulations on the peanut challenge. How many RAST tests has your son had for peanut? Did they gradually go down over time?
Kate[/quote]

Hi Kate,

I live in windsor, and see a pedatric allergist in town. We used to take my son to London for allergist visits because we were unhappy with the selection of allergist in the city initally. Then his doctor in London said that there was a new allergist coming to our area and he was fabulous. He asked if we would like to transfer care to him. We reluctently agreed since we had heard nothing of this doctor. I have to say we are really pleased with him thus far. He has great bedside manner and seems knowledgable. Apparently he is one of the only docs in this area that even do food challenges. Not even his old doctor does them anymore. The only thing is his doctor only does them once a month, so if you don't book them all at once you are waiting at least three months for the first available app't. That's why i booked the next five already. I figure i will cancel them if i need to, but at least we are not waiting years to figure this out. Especially since there are sooo many tree nuts to challenge.

My son had a RAST done in London, unfortunately i was never told at the time the actual results..just that my son was not a candidate for a challenge at that point. Interesting enough his new doctor said had my son been his patient three years ago he would've challenged him then. He felt even then his lab values were favorable. He did tell us that his peanut was .35 three years ago, and before his challenge it was .36 I believe. So it only went up ever so slightly. It's so hard to keep it all straight. I dunno what his tree nut RASTs were back then. I know now they are all under 1. He said we could wait forever to have the numbers go into negatives, and this is likely as low as they will go. If we wait, the numbers would likely go up just because he is avoiding the nuts. So we should do this now in his opinion, but ultimately it was our decision. i'm not gonna lie, it was scarey as hell giving him peanuts on Tuesday! I was a nervous wreck. Since the challenge he has had a recess peanut butter cup, and today had half a PB and jelly sandwich plus some recess wafers. No reactions! "knock on wood" We are going to continue to give it to him as ordered by the doctor. We just hope that we have such sucess with the tree nuts. It really is a relief to not have to worry about peanuts now.
He said that he has challenged kids with much higher numbers with sucess, but generally he has around one child each challenge that reacts, so you never know. If the skin test is relatively small, and the rast is below 2 if the child has eaten it before, or under 5 if they have not eaten it than they have a greater chance of success. He typically likes to challenge older kids as they are better able to communicate how they are feeling during the challenges.
When they did his skin tests they picked him something like 36times for all kinds of stuff. Really it seemed that all the redness ran into one another. I dunno how they could get an accurate assess of the size of redness. His neg. control pick didn't react..so i guess that would show that it wasn't just sensitivity, right. I really can't wait until March to have another skin test on these tree nuts. I'm gonna ask them if they can really spread out the picks that way we can get a really good look at the size of redness. You know as much as we thought we knew about all this stuff, we still have so much to learn with all these labs etc..
I hope your daughter outgrows her allergies too. How old is she? My son was 2 when he was tested and now he is 10yrs. We never thought it was a possiblity that at 10yrs he would outgrow them. The doc in London said usually by age 5yrs they outgrow this, and it would likely be for life. I'm so glad he was wrong.
His first tree nut challenge is in April so it will be an anxious time for us, but at least we'll get the answers we are looking for. The doctor said that even if he reacts at least we will have a clearly indicator of how much it takes for him to react to that certain allergen. Not much comfort at the time of reaction i'm sure, but i guess answers none the less. God i pray that he will make it through ok. Scarey stuff!

When they did his skin tests they picked him something like 36times for all kinds of stuff. Really it seemed that all the redness ran into one another. I dunno how they could get an accurate assess of the size of redness

Initally here in the city they did his picks on his back..he was only 2yrs old. They tested fewer then..I believe he was tested for all the tree nuts individually, peanut,egg and milk. Then up in London..pretty much the same. BUt when we visited the new allergist just before the holidays it was the first time he saw him and did a full evaluation. We mentioned that my son seems congested alot and he tested him for not only all the nuts but all kinds of outdoor things like trees, mold, dust etc..His skin tests for all the 'seasonal' stuff was positive, pos. for dust too. Our home backs onto a field and my son lives in it during the warm months. So we have to get a mattress cover etc.. for the dust and he is now taking nasonex for the other stuff and seems to be helping.
He did the skin tests on his inner arms..up in London was on the arms too.
My son is suprizingly strong about it all, not a tear at all. He sits there like a brave little man. When it's all done he just gives a big sigh of relief that the picking is done. But i knew he was surprized at the number of picks because as the nurse was numbering his arms she just kept going and going and he looked up at me with surprize too.
Apprarently the new allergist said each office has different methods of doing skin test, thus affecting results. Up in London they used a pick and twist method. It send the needle much deeper into the tissue and can make the skin results more exagerated. His office did just a quick pick.

Never done RAST tests - our son had an anaphylactic reaction 2 years ago after eating walnuts (immediate throat swelling shut - he described it as "something is stuck in my throat" - when he was 3, he said the same thing when he ate a pecan) which required an epipen (via me!) and a 3 hour stay at the hospital. His first reaction (when we didn't know he had the allergy) was to pecans (definitely systemic as well though we didn't know it at the time - age 3 - gave him ventolin, benadryl (which he threw up), and let him fall asleep - how horrific to think of it now) and he's had a skin reaction (itchy, itchy eyes when he played cards at a table that someone had eaten walnuts at 8 hours earlier) to unseen walnut oil or residue. For us, there is no point. He is still definitely allergic - will bring him back for skin tests in maybe two years - he's 10 and hasn't visited an allergist since he was 5.

BUT I am thrilled for you! I believe the kids who outgrow it are the ones that have always had a small reaction to tests and have never had a reaction of sorts. Good luck - let us know how it goes. I have heard the stat for outgrowing a peanut allergy (which our son does NOT have) is 20% and the latest stat I heard for outgrowing tree nuts was 7%. Unfortunately I truly believe that our son will not be part of the 7%.

Our son has only had RAST done for peanut. He had his initial test just before starting grade 1, and the result was 62.1 We just had the RAST repeated this past fall (our son is now in Grade 4), due to the annual skin test being 5mm smaller, and the result was 21.7 so it has come down a lot, but still way too high for a challenge...but it gives us some hope that maybe, just maybe, he will outgrow it

My daughter has many anaphylactic allergies. The doctors at Sick Kids have told me that skin tests can be unreliable as can rast tests. My daughters peanut rast is 55.52 just to give you a comparison to your child test. I was told that almost anyone, even with no history of a reaction, will show a slight result on their rast test. .36 is low so that is why they do the oral challenge. Definately worth while, if it means less restrictions on your childs diet. The doctors have always told me they rely more heavily on the history of reactions than the actual test. Make sure when you do the oral challenge that you hang out at the hospital for a while. They usually start the oral challenge with a minute amount and gradually increase it. This is done over several hours and they watch the patient very carefully. I would still make sure you have everything you need ( epipen, benadryl) in case of a delayed reaction...that is from experience.

Wow, when i hear of your kids reactions and lab values i am shocked at how much more severe they are. It makes me feel like there is some hope that my son will one day be able to eat all nuts without problems.His values seem sooo much lower than your children's values. His inital reaction was much less severe too..granted he only ate a smear of the PB and he had hives wherever it touched and his eye swelled shut. BUT at that very moment i gave him benadryl and rushed to the doctors....it never involved his respiratory system..thankfully.
I guess time will tell us more esp.with all the food challenges coming up. Thanks so much for sharing your experiences and lab values with me. It is greatly appreicated. I do hope that each one of you one day will experience the joy of the doctor saying, "he/she has outgrown their allergy to..."...It was such a blessing for us to hear those words for peanuts.
I'm happy to report my son has gone approx.two weeks eating various PB things and no reactions thus far. Miracles do happen.

There are a whole bunch more (seeds and nuts etc.) that are in the "High levels of allergen" range, but I wont bother listing them.

The allergist who ordered the above RAST test did so because she said DS's skin tests didn't tell her a thing, since his arm welted up after her SPT. She said he's the kind of kid that reacts to skin contact with anything. He's not that kind of a kid, because he never gets hives from contact to 'safe' things. Long story (I'll try to shorten it) but she's continued to order SPTs (like every few months) and I think I offended her by asking why she's continually ordering them if they don't tell her anything. My son doesn't like the experience and I don't want to subject him to it if it's unreliable.

Erikas mum, your doctors seem to have a great attitude, relying on family history of reactions. I wish more mainstream doctors were trained to value their patients' histories.

There are a whole bunch more (seeds and nuts etc.) that are in the "High levels of allergen" range, but I wont bother listing them.

The allergist who ordered the above RAST test did so because she said DS's skin tests didn't tell her a thing, since his arm welted up after her SPT. She said he's the kind of kid that reacts to skin contact with anything. He's not that kind of a kid, because he never gets hives from contact to 'safe' things. Long story (I'll try to shorten it) but she's continued to order SPTs (like every few months) and I think I offended her by asking why she's continually ordering them if they don't tell her anything. My son doesn't like the experience and I don't want to subject him to it if it's unreliable.

Erikas mum, your doctors seem to have a great attitude, relying on family history of reactions. I wish more mainstream doctors were trained to value their patients' histories.

Suzanne, thanks for your post. It's awesome to hear about your son!

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I'm so sorry to hear you are having such difficulties with your allergist. I can only imagine how frustrating it is for you and your son. The inital allergist here in the city who saw my son was horrible to put it lightly, but at the time he was the only pediatric allergist. I went back to his pediatrican and said, "there is no way i will take my son to see that doctor again. We are willing to travel to London if need be for good care." So he found us a doctor up there and he was wonderful. His pediatrican had clearly heard these same words from other parents because he said to me, "well, i guess i will have to stop sending people to him. I've had lots of complaints". So clearly he knew of this doctor's history before he sent us there, and if we hadn't pushed we would have been stuck with him. Yes, it was more hassle to drive two hours to the doctor each year but at least my son got good treatment and we found a doctor we could work with. Now we are back in the city with this new doctor and we are really pleased thus far.
Do you have any other options? Can you request a new allergist too? I too don't understand why the doc would put your son through something so unpleasent esp. if the doc said it tells nothing. I know RAST tests are expensive and take a long time for results to come in, so maybe thats the doc's thinking.
I can see your son's lab values are really high too. I guess i should be really pleased with my son's levels. I'm trying not to get too excited or optimistic for fear of being greatly disappointed should he fail the challenges.
Thanks for taking the time to respond to my posting. Take care.
Suzanne

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